Type 1 diabetes: causes signs treatment

Type 1 diabetes is a disorder of sugar metabolism due to pancreatic dysfunction. In-body antibodies (autoantibodies) destroy the insulin-producing cells in the pancreas so that too little or no insulin is produced. People with type 1 diabetes need to inject insulin for life to lower their blood sugar levels. Read all about diabetes type 1 here!

Type 1 Diabetes

Type 1 diabetes: description

Diabetes mellitus type 1 is a kind of diabetes. The central role in the control of blood sugar plays the messenger insulin, which is formed in the pancreas. In type 1 diabetes, the insulin-producing cells are damaged by the body's immune system and insufficient insulin is produced.

Type 1 diabetes is significantly less common than type 2 diabetes. Only about five percent of diabetes mellitus is associated with type 1 diabetes. The disease can occur at any age but is increasingly being diagnosed at a young age. According to some researchers, the incidence of type 1 diabetes mellitus is increasing in Pakistan and throughout the world. The causes are unknown. In Pakistan USA and other countries, about 18 out of every 100,000 people are affected.

LADA diabetes (latent autoimmune diabetes with onset in adults)

LADA diabetes is a type 1 diabetes that only occurs in adulthood. As a rule, diabetes-1 patients are between 12 and 24 years old at diagnosis. By contrast, LADA diabetes usually occurs after the age of 30 and can also be explained by an autoimmune reaction of the body with concomitant destruction of the insulin-producing beta cells. Due to the comparatively untypical age for type 1 diabetes and the rather slowly developing symptoms, a LADA is often confused with type 2 diabetes.

Type 1 diabetes: symptoms

Everything important to the typical signs and symptoms of type 1 diabetes read here! Diabetes symptoms.

Type 1 diabetes: causes and risk factors

Type 1 diabetes is the result of the destruction of the insulin-producing beta cells of the pancreas by antibodies of the body (autoantibodies). Only when about 80 percent of the beta cells are destroyed, the diabetes type 1 is noticeable by greatly increased blood sugar levels. But how does insulin deficiency lead to increased blood sugar?

Blood sugar metabolism regulation

The carbohydrates taken in with food are absorbed into the bloodstream via the small intestine, whereupon the blood sugar level rises after eating. The pancreatic beta cells then release the hormone insulin into the blood of the healthy person. Insulin causes the sugar (glucose) from the blood in the cells of various organs (liver, brain, muscle) passes to serve as an energy supplier. In type 1 diabetes this mechanism is disturbed because insufficient insulin can be produced. As a result, the sugar (glucose) can not enter the body's cells and accumulate in the blood.

The exact causes of the dysregulation of the immune system, which leads to the destruction of beta-cells in the pancreas, are not clear. Scientists assume both a genetic influence and various environmental influences as the cause of the development of type 1 diabetes.

Diabetes Type 1 - Genetic causes

About ten percent of Type 1 diabetes patients have a family member who also has type 1 diabetes. The disease can, therefore, be inherited if it is caused by a genetic defect. In the meantime, around 20 different gene alterations have been linked to the development of type 1 diabetes. As a rule, there are several gene changes that together lead to diabetes mellitus type 1.

A group of genes that are located almost exclusively on chromosome 6 seems to be particularly influential: the so-called human leukocyte antigen system (HLA system) has a significant influence on the control of the immune system. Certain HLA constellations such as HLA-DR3 and HLA-DR4 are associated with an approximately four to six-fold increased risk of type 1 diabetes mellitus. Expectant parents suffering from the disease can have HLA typing done to determine the approximate risk of disease to their child.

Diabetes 1 - environmental factors

The emergence of autoantibodies, which attack the insulin-producing tissue of the pancreas in diabetes type 1, can be influenced according to current knowledge, especially in the first few months of life by external factors. The immune system of an infant gets in contact with various new substances (antigens) every day. In this case, antibodies are formed against harmful substances foreign to the body, which leads to the destruction of the substance classified as alien to the body upon renewed contact. In type 1 diabetes, these antibodies are falsely generated against the body's own cells. This results in a reaction of the immune system against the body's own structures (autoimmunity).

So far, no clear causal relationship between type 1 diabetes and specific individual factors has been demonstrated. However, there has been a link between childhood vitamin D deficiency, recurrent childhood respiratory infections, and type 1 diabetes. An infection of the mother with various viruses (rubella, herpes, cytomegalovirus) during pregnancy is also attributed to the type 1 diabetes of the child.

It is also striking that type 1 diabetes mellitus is more common with other autoimmune diseases. These include, for example, Hashimoto's thyroiditis, gluten intolerance (celiac disease), Addison's disease and autoimmune gastritis (type gastritis).

Type 1 diabetes: examinations and diagnosis

If you suspect diabetes mellitus type 1, the right contact person is your family doctor (if you are a pediatrician) or a specialist in internal medicine and endocrinology/diabetology. Through a detailed description of the symptoms and possible pre-existing conditions, you can already provide the doctor with valuable information about your current state of health. The doctor may ask you the following questions during the first interview:

• Did you have to let more water lately? 
•  Do you suffer from constant thirst, even though you drink a lot?
•  Do you often feel weak and shaky? 
•  Did you accidentally lose weight? 
•  Is someone diabetic type 1 in your family?

Following the interview, the doctor will physically examine you, give you a container for a urine sample to be delivered, and schedule a new appointment for blood because you will need to appear sober (eight hours without food).

Type 1 diabetes: treatment

Diabetes type 1 is based on an absolute insulin deficiency, which is why patients have to replace insulin by syringe for life. Previously, cattle and pig insulin were often injected, while today only artificially produced insulin is used. Patients should always carry insulin syringes and blood glucose meter. Nutritionists and dieticians educate patients on the effects of the disease on their lifestyle and diet.

Diabetes education

Type 1 diabetic patients should attend special diabetes education immediately after diagnosis. Here they learn to estimate the carbohydrate content of various foods and how much insulin the body needs for which foods. In order to be able to carry out a conscientious insulin therapy, various things have to be considered:

A carbohydrate unit (also referred to as bread unit) is equivalent to ten grams of carbohydrates, which increase blood sugar levels by about 30 to 40 milligrams per deciliter (mg/dl). An insulin unit (IU) lowers blood sugar by about 30 to 40 milligrams per deciliter. The daily requirement for insulin at a standard level is 40 insulin units on average. In addition, the insulin sensitivity of the body cells differs at different times of the day. In the morning, the human needs twice as much insulin for a carbohydrate unit as it does at midday.

Conventional insulin therapy

In conventional (conventional) insulin therapy, patients inject insulin according to a set schedule. The insulin injection then takes place either twice or three times daily at fixed times and at fixed dosages. On the one hand, this predetermined scheme is much easier to apply and therefore more suitable for patients with limited learning or memory abilities.

Another advantage is that there is no need for constant blood glucose measurements. On the other hand, this rigid scheme leaves the patient relatively little room for maneuver, for example, if they want to spontaneously change the eating plan. In addition, the blood sugar can not be adjusted as uniformly with conventional insulin therapy, as is possible with the intensified insulin therapy (s.u.). Consequential damages of diabetes mellitus are therefore to be expected in this scheme rather than in intensified insulin therapy.

Intensified insulin therapy (basic bolus principle)

In the context of intensified insulin therapy, long-acting insulin is usually injected once or twice a day to cover about half of the basic insulin requirement. Immediately before a meal, the patient's blood sugar is measured and normal insulin or short-acting insulin is added (bolus). The amount of insulin injected varies according to the composition of the meal and the time of day. The basic bolus principle requires good patient cooperation (compliance), as regular measurements are necessary to prevent over- or under-sugar.

A big advantage of the intensified insulin therapy is that the patient is free in the choice of food as well as the range of motion because the blood sugar is always adjusted. If the blood glucose levels are permanently well-adjusted, the risk of secondary diseases decreases considerably.

Insulin Pump

Especially in young diabetics (type 1) is often a diabetes pump used. The patient wears a fine needle in the abdominal fat, which is connected via a thin tube with an approximately fist-sized pump. The pump can be mounted in a small pocket on the belt and is therefore not visible from the outside. The insulin pump regularly measures blood sugar and then delivers specified amounts of insulin to the subcutaneous fat tissue, thereby meeting the basic daily requirement. At mealtimes, a freely selectable amount of bolus insulin can be added by pressing a button. The insulin cartridges are regularly replaced or filled in the pump.

The pump should be adjusted and adjusted at a specialized diabetes practice or clinic. Especially for children, the insulin pump offers a lot of freedom. Many patients can not imagine being connected to a device before. If necessary, you can also disconnect the diabetes pump (for example, for a shower). During sports, however, the pump should be worn. Many patients report a valuable improvement in the quality of life due to the insulin pump.